Provider Demographics
NPI:1043552748
Name:KAISERLIK, DELORES M (RN)
Entity type:Individual
Prefix:MS
First Name:DELORES
Middle Name:M
Last Name:KAISERLIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6795 480TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069
Mailing Address - Country:US
Mailing Address - Phone:612-419-6430
Mailing Address - Fax:
Practice Address - Street 1:460 S ELIOT AVE
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069-6505
Practice Address - Country:US
Practice Address - Phone:320-358-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-213695-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse